Your patient was ejected off of a motorcycle 50 feet onto a concrete sidewalk.
Scene Size Up
You have 1 patient
Scene Size Up
Your partner has called for advanced life support. They are at least 45 minutes away.
Scene Size Up
Your partner has moved into position to manually stabilize the patient's cervical spine.
Initial Assessment
Your general impression of the patient is that of an unhelmeted hispanic male in his 30's involved in a high speed motorcycle crash with significant damage to the bike and the vehicle involved, The patient is laying approximately 50 feet away from the site of impact. Patient appears to be unconscious and has bleeding from an unknown source. You hear snoring sounds as you approach him.
Initial Assessment
The patient does not respond to verbal stimulus. The patient groans when a trapezius pinch is applied.
Initial Assessment
Your patient is unresponsive with sig MOI - sounds like an apparent life threat to me!
Initial Assessment
Your patient has snoring respirations but the airway is otherwise clear of secretions, blood, vomit, small toys, etc. How would you like to open the airway?
Initial Assessment
Your partner opens the airway using a modified jaw thrust maneuver. The snoring stops and the airway is clear. What would you like to do next?
Initial Assessment
The patient is breathing shallowly at about 30/minute with moderate work. Lung sounds are diminished on the right and clear on the left.
Initial Assessment
Oxygen therapy is started using a bag valve mask connected to oxygen at 15 LPM.
Initial Assessment
This is an appropriate method to deliver oxygen to this patient.
Initial Assessment
There does not appear to be any airway injuries.
Initial Assessment
A quick scan of the patient reveals dark red bleeding from the right femur area. A cop (here's a first!) applies direct pressure for you using a bulky trauma dressing. Bleeding is under control.
Initial Assessment
Patient has a weak radial pulse at about 52/min. Carotid pulse is a bit stronger and also at 110/min.
Initial Assessment
The skin is cool, pale, and diaphoretic.
Initial Assessment
You decide that this patient will be a high priority for transport.
Focused History and Exam
Where would you like to start your 60 second rapid trauma assessment?
Focused History and Exam
Assessment of the head with firm area to the top of the head, no drainage from nose or ears, airway patent and clear. Facial bones stable.
Focused History and Exam
Trachea is midline, jugular veins are flat, no injury noted to the neck, spine has no tenderness (your patient is unconscious after all). Your partner applies a cervical collar.
Focused History and Exam
Clavicles are stable
Focused History and Exam
Flail segment noted to the right side with diminished lung sounds as noted previously. Left side clear. No other injury noted.
Focused History and Exam
Abdomen is soft and non-tender.
Focused History and Exam
Pelvis is stable.
Focused History and Exam
Right leg is clear besides previously controlled bleeding with no other findings. Left lower leg deformed, no major bleeding. Distal pulses present but weak, no motor sensory.
Focused History and Exam
Right arm is clear, no findings. Left lower arm deformed. Pulses present but weak bilaterally. No motor or sensation.
Focused History and Exam
On your partner's count, you roll the patient on his side and assess the back. No findings are noted. The patient is rolled onto a long spineboard and secured to the board.
Focused History and Exam
Your partner obtains a quick set of vital signs: P52, BP 162/64, R12 via BVM.
Focused History and Exam
No one is around that knows the patient. There are no medical alert bracelets. The patient's wallet contains a driver's license which indicates he is an organ donor. Witnesses report the patient crossed the center line while trying to avoid some chickens that were crossing the road. Patient struck the front end of a now compact car at significant speed. Minimal skid marks are present and the speed limit is 50 MPH on this road. Time to transport! You load the patient in the ambulance and begin a detailed physical exam. Where would you like to start?
Detailed Physical Exam
Scalp with firm area to top of head, pupils are sluggish, facial bones intact, no drainage from ears or nose. Airway remains patent.
Detailed Physical Exam
Cervical collar is already applied. Trachea remains midline, jugular veins are flat.
Detailed Physical Exam
Clavicles still intact.
Detailed Physical Exam
You splint the flail segment on the right side with a bulky dressing. Right side with diminished lung sounds as noted previously. Left side clear. No other injury noted.
Detailed Physical Exam
Abdomen remains soft and non-tender.
Detailed Physical Exam
Stable.
Detailed Physical Exam
Quick assessment of the genitalia finds nothing significant. No priapism.
Detailed Physical Exam
Right leg with bleeding still under control. Left leg splinted to the back board. Pulses present, no motor or sensory.
Detailed Physical Exam
Right arm clear with no new findings, left arm splinted to backboard. Pulses present, no motor or sensory.
Detailed Physical Exam
Back remains as previously assessed. Patient is immobilized to long spine board.
Detailed Physical Exam
All deformities are splinted to the backboard, flail chest segment is splinted to the chest, bleeding is under control. Medic is still 35 minutes out - guess we got this one under control!
Ongoing Assessment
Repeat vital signs: P58, R12 via BVM, BP 168/60 (that pulse pressure is widening up! What is the name of the three signs this patient is displaying?
Bonus
Irregular respirations, bradycardia, and widening pulse pressure - indicative of increasing intracranial pressure! Your patient arrives at General Hospital's Trauma Ward where he is greeted by a team of overexcited residents. One intubates the patient after 3 attempts while nursing starts 2 large bore IVs in the right and left AC. X-ray confirms tube placement and finds a C6-C7 spinal fracture, fractures to left radial/ulnar, fracture to right tibia/fibula. CT scan finds an epidural hematoma. Patient is sent to the OR, spends a week in the ICU, and enjoys 6 weeks at the local rehabilitation facility. He gets extremely upset when asked, 'why did the chicken cross the road?'
Quiz Playlist
Details
More Info:
This quiz reviews the systematic assessment and management of the trauma patient as prescribed by the NREMT. You can get more information about becoming a certified EMT at www.code1web.com
In order to create a playlist on Sporcle, you need to verify the email address you used during registration. Go to your Sporcle Settings to finish the process.
Comments